Port fixation with filament actuating member

ABSTRACT

A method for performing a surgical procedure includes the steps of: accessing a surgical site with an access member, the access member having proximal and distal ends, and defining a longitudinal axis, the access member having an elongated element operatively connected thereto; transitioning the access member from a first condition having a first dimension orthogonal to the longitudinal axis to a second condition having a second dimension orthogonal to the longitudinal axis greater than the first dimension by drawing the elongated element in a proximal direction; anchoring the access member within a tissue passage leading to the surgical site when in the second condition thereof; and introducing a surgical object through a longitudinal opening of the access member to perform a surgical task.

CROSS REFERENCE TO RELATED APPLICATION

The present application is a continuation of copending U.S. patentapplication Ser. No. 12/641,906 filed on Dec. 18, 2009, which claims thebenefit of and priority to U.S. Provisional Application Ser. No.61/153,078 filed on Feb. 17, 2009 (now expired), the entire contents ofwhich are incorporated herein by reference.

BACKGROUND

1. Technical Field

The present disclosure relates to surgical access apparatus forpositioning within an opening formed in a patient's tissue. Moreparticularly, the present disclosure relates to surgical accessapparatus that are repositionable to facilitate anchoring within apercutaneous opening, and capable of removably receiving one or moresurgical instruments.

2. Background of the Related Art

In contemporary medical practice, many surgical procedures are performedthrough small incisions formed in the skin, as compared to the largerincisions typically required in traditional procedures, in an effort toreduce both patient trauma and recovery time. Generally, such proceduresare referred to as “endoscopic,” unless performed in the patient'sabdomen, in which case the procedure is referred to as “laparoscopic,”or on a joint, ligament, or the like, in which case the procedure isreferred to as “arthroscopic.” Throughout the present disclosure,“endoscopic,” “laparoscopic,” and “arthroscopic” procedures may becollectively referred to as “minimally invasive” procedures.

Typically, a minimally invasive surgical procedure will include the useof a surgical access apparatus or portal member to facilitate entry intoa surgical worksite positioned beneath the patient's tissue withsurgical instrumentation, e.g., endoscopes, obturators, staplers, andthe like. A typical surgical access apparatus defines a passageway orlumen through which the surgical instrumentation is inserted and theprocedure is carried out.

While many varieties of surgical access apparatus are known in the art,a continuing need exists for a surgical access apparatus that may bereleasably and reliably secured within the patient's tissue throughoutthe course of a minimally invasive procedure.

SUMMARY

In one aspect of the present disclosure, a method for performing asurgical procedure, includes the steps of:

providing a surgical access apparatus comprising:

-   -   a housing having proximal and distal ends and being configured        to removably receive at least one surgical instrument;    -   a tubular member extending distally from the housing, the        tubular member being adapted to removably receive the at least        one surgical instrument and repositionable between a first        position, in which the tubular member is configured for at least        partial insertion into an opening in the tissue, and a second        position, in which the tubular member is configured to        facilitate anchoring of the tubular member within the tissue;    -   a connective member secured to the tubular member;    -   at least one filament secured to the connective member and        extending proximally therefrom; and    -   at least one manual member secured to the at least one filament,        the at least one manual member being configured and dimensioned        for grasping by a clinician such that the at least one filament        is movable in a proximal direction to facilitate selective        repositioning of the tubular member from the first position to        the second position;

advancing the tubular member distally into an opening in the tissuewhile in the first position; and

moving the at least one manual member in a proximal direction to causecorresponding movement of the connective member to thereby repositionthe tubular member from the first position to the second position toanchor the surgical access apparatus within the tissue.

The housing may include locking structure in which the method includesthe step of engaging the locking structure with one or more of the atleast one filament and the at least one manual member to maintain thetubular member in the second position. The step of repositioning thetubular member from the first position to the second position may causea portion of the tubular member to lie in a plane substantially parallelto the tissue.

The tubular member may include a mesh of braided fibers and, whereinduring the step of moving the at least one manual member, the mesh isadapted for radial expansion to facilitate passage of the surgicalinstrument into the lumen of the tubular member. The method may furtherinclude the step of introducing a surgical instrument through thesurgical access apparatus and optionally the step of establishing asubstantially fluid-tight seal about the surgical instrument with theconnective member. The mesh of braided fibers may include asubstantially elastic material such that during the step of introducingthe surgical instrument through the surgical access apparatus, the axiallength of the tubular member changes. In the alternative, the mesh ofbraided fibers may include a substantially inelastic material such thatduring the step of introducing the surgical instrument through thesurgical access apparatus, the axial length of the tubular memberremains substantially constant.

In another aspect, a method for performing a surgical procedure includesthe steps of:

accessing a surgical site with an access member, the access memberhaving proximal and distal ends ends, and defining a longitudinal axis,the access member having an elongated element operatively connectedthereto;

transitioning the access member from a first condition having a firstdimension orthogonal to the longitudinal axis to a second conditionhaving a second dimension orthogonal to the longitudinal axis greaterthan the first dimension by drawing the elongated element element in aproximal direction;

anchoring the access member within a tissue passage leading to thesurgical site when in the second condition thereof; and

introducing a surgical object through a longitudinal opening of theaccess member to perform a surgical task.

The method may further include the step of securing the elongatedelement to substantially maintain the access member in the secondcondition thereof. A connective member may be positioned within thelongitudinal opening of the access member and connected to the accessmember and the elongated element, whereby during the step oftransitioning, the elongated member draws the connective member in aproximal direction to cause segment of the access member to be displacedin a radial outward direction relative to the longitudinal axis. Themethod may further include the step of establishing a substantial sealabout the surgical object with the connective member.

The access member may include a tubular braided mesh, and wherein,during the step of transitioning, mesh segments of the braided mesh aredisplaced in the radial outward direction relative to the longitudinalaxis to engage tissue adjacent the tissue passage. The tubular braidedmesh may comprise elastic material, whereby, during the step oftransitioning, reduction of a longitudinal length of the tubular braidedmesh is substantially minimized or remains substantially constant.

These and other features of the surgical access apparatus disclosedherein will become more readily apparent to those skilled in the artthrough reference to the detailed description of various embodiments ofthe present disclosure that follows.

BRIEF DESCRIPTION OF THE DRAWINGS

Various embodiments of the present disclosure are described herein belowwith references to the drawings, wherein:

FIG. 1 is a side, schematic view of a surgical access apparatusincluding a housing and a tubular member in accordance with oneembodiment of the present disclosure, wherein the tubular member isshown in a first position;

FIG. 2 is a side, schematic view of the surgical access apparatus shownin FIG. 1 illustrating the tubular member in a second position within atissue tract formed in a patient's tissue;

FIG. 3 is a side, schematic view of an alternative embodiment of thesurgical access apparatus shown in FIG. 1;

FIG. 4 is a side, cross-sectional view of one embodiment of lockingstructure for use with the surgical access apparatus shown in FIG. 1illustrating the locking structure in a locked condition;

FIG. 5 is a side, cross-sectional view of the locking structure shown inFIG. 4 illustrating the locking structure in an open condition; and

FIGS. 6 and 7 are side, schematic views of another embodiment of thesurgical access apparatus shown in FIG. 1 including a membrane disposedabout the tubular member, the tubular member being respectively shown inthe first and second positions thereof.

DETAILED DESCRIPTION OF THE EMBODIMENTS

In the drawings, and in the following description, like referencesnumerals will identify similar or identical elements. Throughout thefollowing description, the term “proximal” will refer to the end of thepresently disclosed surgical access apparatus, or component thereof,that is closest to the clinician during proper use, while the term“distal” will refer to the end that is furthest from the clinician.Additionally, the term “tissue tract” should be understood as referringto any opening in a patient's tissue, whether formed by the clinician orpre-existing.

With reference to FIGS. 1 and 2, a surgical access apparatus 10 isdisclosed that is removably positionable within a tissue tract oropening 12 formed in a patient's tissue “T.” The surgical accessapparatus 10 is employable during the course of a surgical procedure,e.g., a minimally invasive procedure, to facilitate access to a surgicalworksite “W,” such as a patient's underlying cavities, tissues, organs,or the like, with one or more surgical instruments “I.” In one aspect ofthe present disclosure, the surgical access apparatus 10 includes ahousing 100, a tubular member 200, a connective member 300, one or morefilaments 400, and at least one manual member 500.

The housing 100 includes respective proximal and distal ends 102, 104,and may be fabricated from any suitable biocompatible material includingmoldable polymeric materials, stainless steel, titanium, or the like.The housing 100 is configured for manual engagement by a clinician andincludes an opening 106 extending therethrough that is configured forthe reception and passage of the surgical instrument “I,” which definesan outer transverse dimension “D|.” The housing 100 includes an outerwall 108 defining a flange 110 with a distal surface 112, and mayoptionally include an internal seal or valve (not shown), such as aduck-bill or zero-closure valve, that is adapted to close in the absenceof the surgical instrument “I”. Examples of suitable internal seals orvalves are discussed in commonly assigned U.S. Pat. Nos. 5,820,600 toCarlson, et al. and 6,702,787 to Racenet et al., which issued on Oct.13, 1998 and Mar. 9, 2004, respectively, the entire contents of whichare incorporated by reference herein. The housing 100 further includeslocking structure 600, which will be discussed in detail below.

The tubular member 200 extends distally from the housing 100 along alongitudinal axis “A” a length “L,” and includes a proximal end 202 anda distal end 204. The tubular member 200 is configured as a braid 206formed by a mesh of biocompatible fibers 208, and defines an axial lumen210 therethrough that is configured for the reception and passage of thesurgical instrument “I”. Specifically, the lumen 210 of the tubularmember 200 defines an internal transverse dimension “Dr” that is lessthan the outer transverse dimension “Di” of the surgical instrument “I.”Consequently, insertion of the surgical instrument “I” into the lumen210 of the tubular member 200 will cause the tubular member 200 toexpand outwardly along an axis “B” that is transverse, e.g., orthogonal,in relation to the longitudinal axis “A.” In one embodiment of thetubular member 200, the fibers 208 may be formed from a substantiallyelastic material, which allows the length “L” of the tubular member 200to remain substantially constant during outward expansion. However, inan alternative embodiment, the fibers 208 comprising the braid 206 maybe formed from a substantially inelastic material, e.g., polyamidefiber, stainless steel, or the like, such that tubular member 200experiences a measure of shortening along the longitudinal axis “A” uponthe introduction of surgical instrument “1”, further details of whichmay be obtained through reference to U.S. Pat. No. 5,431,676 to Dubrulet al., the entire contents of which are incorporated by referenceherein. The fibers 208 comprising the braid 206 may be of any suitableconfiguration, including but not limited to round, flat, ribbon-like, orsquare.

With continued reference to FIGS. 1 and 2, the connective member 300will be discussed. The connective member 300 may be formed from anysuitable biocompatible material, including but not limited to polymericmaterials or rubber. Desirably, the connective member 300 is formed froma resilient, substantially non-rigid material such that the connectivemember 300 is capable of deformation, e.g., compression, to facilitateinsertion of the tubular member 200 into the tissue tract 12. In onespecific embodiment of the present disclosure, the connective member 300is formed from an expandable material such that the connective member300 is deformed radially as the surgical instrument “I” is passedtherethrough. In this embodiment, the connective member 300 forms asubstantially fluid-tight seal with the surgical instrument “I” toinhibit the escape of fluid, e.g., insufflation gas in the case of alaparoscopic surgical procedure or an irrigant solution in the case ofan arthroscopic surgical procedure, from the surgical worksite “W” aboutthe tubular member 200.

The connective member 300 is secured to the tubular member 200, and maybe positioned at any suitable location along the length “L” thereof. Forexample, the connective member 300 may be positioned adjacent the distalend 204 of the tubular member 200, as shown in FIGS. 1 and 2. Theconnective member 300 may positioned either within the lumen 210 (FIGS.1 and 2), or alternatively, the connective member 300 may be positionedexternally of the tubular member 200, i.e., the connective member 300may be secured to an outer surface 212 of the tubular member 200 (FIG.3).

Referring again to FIGS. 1 and 2, the surgical access apparatus 10 isillustrated as including a pair of filaments 400. In alternativeembodiments of the present disclosure, however, the filaments 400 may beincluded in either greater or fewer numbers. The filaments 400 aresecured to the connective member 300 such that the filaments 400 extendproximally therefrom, i.e., towards the housing 100, and may be securedto the connective member 300 in any suitable manner, such as through theuse of adhesives or heat staking, for example. The filaments 400 areused to reposition the tubular member 200 from a first (initial)position (FIG. 1) to a second (activated) position (FIG. 2), and may beany members suitable for this intended purpose, including but notlimited to surgical sutures, tape, etc.

In the first position, the tubular member 200 defines an initial outerdimension “D|” that is substantially uniform along the length “L.” Thelength “L” of the tubular member 200 in the first position may varydepending on the intended usage of the surgical access apparatus 10, butin general, will lie substantially within the range of about 10 cm toabout 25 cm. However, a tubular member 200 that is substantially longeror shorter is not beyond the scope of the present disclosure. Theinitial outer dimension “D|” of the tubular member 200 is smaller thanthe dimensions of the tissue tract 12 such that the tubular member 200can be inserted and advanced distally through tissue tract 12 willlittle or no resistance when the tubular member is in the firstposition.

Upon the application of a force to the filaments 400 in the direction ofarrow 1 (FIG. 1), e.g., by pulling or drawing the filaments 400proximally, the tubular member 200 is shortened along the longitudinalaxis “A”, thereby transitioning into the second position (FIG. 2). Inthe second position, the tubular member 200 defines a length “L2” thatis considerably less than the initial length “L” defined by the tubularmember 200 in the first position. Additionally, in the second position,the tubular member 200 defines a tissue engaging portion 214 having anouter dimension “D2” that is considerably greater than the outerdimension “Di” defined by the tubular member 200 in the first position.The tissue engaging portion 214 contacts the patient's tissue “T” aboutthe tissue tract 12 and, in conjunction with the flange 110 of thehousing 100, facilitates anchoring of the surgical access apparatus 10.It is envisioned that the tissue engaging portion 214 may also act to atleast partially form a seal with the patient's tissue “T” tosubstantially reduce the likelihood that any fluids present within thesurgical worksite “W,” such as insufflation gasses or irrigantsolutions, will escape around the surgical access apparatus 10.

With continued reference to FIGS. 1 and 2, the aforementioned manualmembers 500 are secured to the filaments 400, and are configured anddimensioned for engagement by the clinician to assist the clinician intransitioning the tubular member 200 from the first position (FIG. 1) tothe second position (FIG. 2). Although illustrated as ring-shaped, itshould be understood that the manual members 500 may be configured anddimensioned in any manner suitable for this intended purpose. Generally,the number of manual member 500 included as part of the surgical accessapparatus 10 will correspond to the number of filaments 400. Forexample, as seen in FIGS. 1 and 2, the surgical access apparatus 10includes a pair of filaments 400 connected to a pair of manual members500. It is also envisioned, however, that each of the filaments 400 maybe secured to the same manual member 500.

As previously indicated, the housing 100 of the surgical accessapparatus 10 includes locking structure 600, which acts to maintain thetubular member 200 in the second position (FIG. 2). As seen in FIGS. 1and 2, in one embodiment, the locking structure 600 includes one or morechannels 602 that are formed in the housing 100, as well as one or moreengagement members 604. The channels 602 extend at least partiallythrough the housing 100 to one or more egresses 114 (FIG. 2) formedeither in a proximal-most surface 116, as shown, or an outer wall 108 ofthe housing 100. In the illustrated embodiment, the filaments 400 extendthrough the channels 602 for grasping by the clinician, e.g., via themanual members 500, to thereby transition the tubular member 200 intothe second position (FIG. 2). Upon repositioning of the tubular member200 from the first position (FIG. 1) to the second position (FIG. 2),either or both of the filaments 400 and the manual members 500 aresecured about the engagement members 604, e.g., by tying. The engagementmembers 604 may be any structure suitable for the intended purpose ofreleasably securing the filaments 400, such as the illustrated hook, forexample.

Referring now to FIGS. 4 and 5, in an alternative embodiment, thelocking structure 600 includes the aforementioned channels 602 and alocking mechanism 606. The locking mechanism 606 includes a lockingmember 608 having an aperture 610 formed therein, a handle portion 612,and a biasing member 614. The aperture 610 is configured to receive thefilaments 400, and the handle portion 612 is configured for manualengagement by the clinician to facilitate transitioning of the lockingmechanism 606 between a locked condition (FIG. 4) and an open condition(FIG. 5). In the locked condition, the aperture 610 is in misalignmentwith the channel 602 such that a portion of the filaments 400 isdisposed between the housing 100 and the locking member 608, effectivelyprohibiting any movement of the filaments 400 and thereby maintainingthe second position of the tubular member 200 (FIG. 2). When the lockingmechanism 606 is in the open condition, however, at least a portion ofthe aperture 610 is aligned with the channel 602 such that the filaments400 may freely extend therethrough. The biasing member 614 urges thelocking mechanism 606 towards the locked condition and may be comprisedof any structure or mechanism suitable for this intended purpose, e.g.,a spring.

In alternative embodiments, the locking mechanism 606 may comprise asingle locking member 608 and a single biasing member 614, as shown inFIGS. 4 and 5, or a plurality of locking members 614 engagable with oneor more biasing members 620.

Referring again to FIGS. 1 and 2, the use and function of the surgicalaccess apparatus 10 will be discussed during the course of a typicalminimally invasive procedure subsequent to the formation of the tissuetract 12.

Prior to insertion of the surgical access apparatus 10, the tubularmember 200 is in the first position (FIG. 1) to facilitate positioningof the tubular member 200 within the tissue tract 12. It should be notedthat the clinician may compress the connective member 300 radially,i.e., towards the longitudinal axis “A,” to further reduce the outertransverse dimension “D|” of the tubular member 200 at the distal end204 to reduce the likelihood of trauma to the tissue “T” duringinsertion. After positioning the distal end 204 of the tubular member200 within the tissue tract 12, the clinician advances the surgicalaccess apparatus 10 distally until the flange 110 abuts the patient'stissue “T.” Thereafter, the clinician draws the filaments 400 proximallytowards the housing 100 to transition the tubular member 200 into thesecond position (FIG. 2) and form the tissue engaging portion 214. Theclinician can then secure the filaments 400 to the locking structure 600in order to maintain the second position of the elongated member 400,thereby anchoring the surgical access apparatus 10 within the tissuetract 12. The surgical instrument “I” can then be inserted into, andadvanced distally through, the lumen 210 extending through the tubularmember 200 to carry out the surgical procedure through the surgicalaccess apparatus 10.

It should be noted that insertion of the surgical instrument “I” mayexpand the tubular member 200 outwardly along the transverse axis “B”into tight-fitting engagement with the patient's tissue “T,” therebyfurther securing the surgical access apparatus 10 and enhancing thequality of the seal formed by the engagement of the tissue “T” with theflange 110 and the tissue engaging portion 214 of the tubular member200.

After completing the procedure and withdrawing the surgical instrument“I” from the tubular member 200, the filaments 400 can be disengagedfrom the locking structure 600, e.g., untied, such that the tubularmember 200 can be returned to the first position (FIG. 1). The surgicalaccess apparatus 10 can then be withdrawn from the tissue tract 12, andthe tissue tract 12 can be closed.

Referring now to FIGS. 6 and 7, in another embodiment, the surgicalaccess apparatus 10 includes a membrane 700 that is disposed about thetubular member 200. The membrane 700 may be composed of any suitablebiocompatible material that is at least semi-resilient in nature andsubstantially impervious to fluids, e.g., insufflation gas or anirrigant solution. Incorporating the membrane 700 may facilitate theinsertion and passage of one or more surgical instruments “I” into andthrough the lumen 210 of the tubular member 200. The membrane 700 may bedisposed about the tubular member 200 along its entire length, or in thealternative, the membrane 700 may be selectively disposed aboutindividual sections of the tubular member 200, e.g., about a proximalsection 216, an intermediate section 218, and/or a distal section 220.

When disposed about the proximal section 216 of the tubular member 200,the membrane 700 engages the patient's tissue “T” upon transitioning ofthe tubular member 200 from the first position (FIG. 6) into the secondposition (FIG. 7). Engagement of the membrane 700 with the patient'stissue “T,” in conjunction with the flange 110 of the housing 100,creates a substantially fluid-tight seal about the tissue tract 12,thereby substantially inhibiting the escape of any fluids from thesurgical worksite “W” about the surgical access apparatus 10.

As previously discussed with respect to the surgical access apparatus 10shown in FIGS. 1 and 2, introducing the surgical instrument “I” to thetubular member 200 may cause the tubular member 200 to expand outwardlyalong the transverse axis “B.” In the embodiment of the surgical accessapparatus 10 seen in FIGS. 6 and 7, the membrane 700 would also beforced outwardly into engagement with the patient's tissue “T.”Accordingly, the membrane 700 may act to further anchor the surgicalaccess apparatus 10 within the tissue “T,” and tighten the seal createdtherewith by the tissue engaging portion 214 and the flange 110.

The above description, disclosure, and figures should not be construedas limiting, but merely as exemplary of particular embodiments. It is tobe understood, therefore, that the disclosure is not limited to theprecise embodiments described, and that various other changes andmodifications may be effected therein by one skilled in the art withoutdeparting from the scope or spirit of the disclosure. Additionally,persons skilled in the art will appreciate that the features illustratedor described in connection with one embodiment may be combined withthose of another, and that such modifications and variations are alsointended to be included within the scope of the present disclosure.

1. A method for performing a surgical procedure, comprising the stepsof: providing a surgical access apparatus comprising: a housing havingproximal and distal ends and being configured to removably receive atleast one surgical instrument; a tubular member extending distally fromthe housing, the tubular member being adapted to removably receive theat least one surgical instrument and repositionable between a firstposition, in which the tubular member is configured for at least partialinsertion into an opening in the tissue, and a second position, in whichthe tubular member is configured to facilitate anchoring of the tubularmember within the tissue; a connective member secured to the tubularmember; at least one filament secured to the connective member andextending proximally therefrom; and at least one manual member securedto the at least one filament, the at least one manual member beingconfigured and dimensioned for grasping by a clinician such that the atleast one filament is movable in a proximal direction to facilitateselective repositioning of the tubular member from the first position tothe second position; advancing the tubular member distally into anopening in the tissue while in the first position; and moving the atleast one manual member in a proximal direction to cause correspondingmovement of the connective member to thereby reposition the tubularmember from the first position to the second position to anchor thesurgical access apparatus within the tissue.
 2. The method of claim 1,wherein the housing includes locking structure and including the step ofengaging the locking structure with one or more of the at least onefilament and the at least one manual member to maintain the tubularmember in the second position.
 3. The method of claim 1, wherein thestep of repositioning the tubular member from the first position to thesecond position causes a portion of the tubular member to lie in a planesubstantially parallel to the tissue.
 4. The method of claim 1, whereinthe tubular member includes a mesh of braided fibers and, wherein duringthe step of moving the at least one manual member, the mesh is adaptedfor radial expansion to facilitate passage of the surgical instrumentinto the lumen of the tubular member.
 5. The method of claim 1, furtherincluding the step of introducing a surgical instrument through thesurgical access apparatus.
 6. The method of claim 5, including the stepof establishing a substantially fluid-tight seal about the surgicalinstrument with the connective member.
 7. The method of claim 5, whereinthe mesh of braided fibers includes a substantially elastic materialsuch that during the step of introducing the surgical instrument throughthe surgical access apparatus, the axial length of the tubular memberchanges.
 8. The method of claim 5 wherein the mesh of braided fibersinclude a substantially inelastic material such that during the step ofintroducing the surgical instrument through the surgical accessapparatus, the axial length of the tubular member remains substantiallyconstant.
 9. A method for performing a surgical procedure, comprisingthe steps of: accessing a surgical site with an access member, theaccess member having proximal and distal ends ends, and defining alongitudinal axis, the access member having an elongated elementoperatively connected thereto; transitioning the access member from afirst condition having a first dimension orthogonal to the longitudinalaxis to a second condition having a second dimension orthogonal to thelongitudinal axis greater than the first dimension by drawing theelongated element element in a proximal direction; anchoring the accessmember within a tissue passage leading to the surgical site when in thesecond condition thereof; and introducing a surgical object through alongitudinal opening of the access member to perform a surgical task.10. The method according to claim 9 including the step of securing theelongated element to substantially maintain the access member in thesecond condition thereof.
 11. The method according to claim 9 includinga connective member positioned within the longitudinal opening of theaccess member and connected to the access member and the elongatedelement, whereby during the step of transitioning, the elongated memberdraws the connective member in a proximal direction to cause segment ofthe access member to be displaced in a radial outward direction relativeto the longitudinal axis.
 12. The method according to claim 10 includingthe step of establishing a substantial seal about the surgical objectwith the connective member.
 13. The method according to claim 9 whereinthe access member includes a tubular braided mesh, and wherein, duringthe step of transitioning, mesh segments of the braided mesh aredisplaced in the radial outward direction relative to the longitudinalaxis to engage tissue adjacent the tissue passage.
 14. The methodaccording to claim 13 wherein the tubular braided mesh comprises elasticmaterial, and whereby, during the step of transitioning, reduction of alongitudinal length of the tubular braided mesh is substantiallyminimized.
 15. The method according to claim 14 wherein the elasticmaterial is dimensioned and configured whereby during the step oftransitioning, the longitudinal length of the tubular braided meshremains substantially constant.